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BACKGROUND: Lyme disease is a multisystem inflammatory disease caused by infection with the tick-borne spirochete Borrelia burgdorferi and is the most common vector-borne infection in the United States. We assessed the efficacy of a recombinant vaccine consisting of outer-surface protein A (OspA) without adjuvant in subjects at risk for Lyme disease. METHODS: For this double-blind trial, 10,305 subjects 18 years of age or older were recruited at 14 sites in areas of the United States where Lyme disease was endemic; the subjects were randomly assigned to receive either placebo (5149 subjects) or 30 microg of OspA vaccine (5156 subjects). The first two injections were administered 1 month apart, and 7515 subjects also received a booster dose at 12 months. The subjects were observed for two seasons during which the risk of transmission of Lyme disease was high. The primary end point was the number of new clinically and serologically confirmed cases of Lyme disease. RESULTS: The efficacy of the vaccine was 68 percent in the first year of the study in the entire population and 92 percent in the second year among the 3745 subjects who received the third injection. The vaccine was well tolerated. There was a higher incidence of mild, self-limited local and systemic reactions in the vaccine group, but only during the seven days after vaccination. There was no significant increase in the frequency of arthritis or neurologic events in vaccine recipients. CONCLUSIONS: In this study, OspA vaccine was safe and effective in the prevention of Lyme disease.

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Initial studies have found that stop-smoking treatments for newly recovering substance abusers have been neither harmful to sobriety nor effective in achieving smoking cessation. The development of more effective stop-smoking treatments for this population could be aided by delineating their particular smoking-related characteristics. This article describes the biopsychosocial characteristics of newly recovering substance abusers that are relevant to smoking cessation, and suggests that there are notable differences between abusers and nonabusers that may contribute to abusers' greater difficulty in quitting smoking. It also recommends changes in existing treatment protocols where applicable and identifies key areas for future research.

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This study compared the cigarette smoking of substance abusers whose primary substance of abuse was cocaine (cocaine group: n = 18) or alcohol (alcohol group: n = 23). Cigarette smoking and smoking topography was assessed daily (via self-report and single cigarette topography assessments) at baseline and following a switch to a cigarette brand with 30% lower nicotine. The alcohol and cocaine groups did not differ at baseline on cigarettes smoked per day, cigarette nicotine, smoking topography, or the Fagerstrom Tolerance Questionnaire. However, the cocaine group exhibited marked increases in compensatory smoking relative to the alcohol group following the 30% reduction in cigarette nicotine, as evidenced by decreases in the average time interval between each puff, p < .05, increases in the total amount of time spent puffing, p < .05, and increases in estimated total amount of time spent puffing per day, p < .05. These findings provide initial data that cocaine and alcohol abusers may titrate nicotine differently and suggest that cocaine abusers may require additional or modified smoking cessation treatments.

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Delineating the characteristics of substance-dependent inpatients who are interested in receiving smoking treatment is critical to developing effective recruitment strategies and interventions for this population. Thus, this study comprehensively assessed and compared substance-dependent inpatients who accepted (n = 75) versus refused (n = 25) a stop-smoking treatment. Univariate analyses found treatment acceptors were younger, more addicted to nicotine, had more smoking-related health problems, had more positive attitudes about quitting smoking, and had more positive attitudes about the relationship between smoking cessation and drug/alcohol sobriety (e.g., believed cessation would positively impact sobriety). Logistic regression revealed that believing inpatient treatment was the best time to quit smoking was the primary factor associated with accepting treatment. Aside from their attitudes about the relationship between smoking cessation and sobriety, substance abusers who accepted smoking treatment appeared similar (e.g., in demographics, smoking behaviors) to nonabusers described in previous studies.

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This paper presents data regarding a residential rehabilitation program that integrates cognitive-behavioral and therapeutic community techniques to treat homelessness and substance abuse. The study cohort was 110 military veterans admitted to a Domiciliary Care for Homeless Veterans program of the Department of Veterans Affairs. The cohort had multiple psychosocial problems at admission, and all had drug/alcohol abstinence as a treatment goal. Structured interviews conducted at 3, 6, 9, and 12 months postdischarge revealed that a substantial proportion had positive outcomes with respect to housing, substance abuse abstinence, employment, and self-rated psychological symptoms. This integrated cognitive-behavioral therapeutic community approach appears to be a viable treatment for this subset of homeless and also may be effective for other populations with similar clinical characteristics.

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This report describes a computer-directed cigarette smoking cessation program that individualizes nicotine fading schedules for smokers based upon their daily smoking behavior. Previous outcome data from minimal intervention and intensive stop-smoking treatment studies are presented. Preliminary urinary cotinine data also are presented to validate the program's underlying assumption that computer-directed nicotine fading results in across-treatment reductions in biological levels of nicotine.

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Attitudes about quitting cigarette smoking were assessed at admission to a substance abuse treatment program for homeless veterans. The majority were interested in quitting smoking, believed that inpatient drug/alcohol treatment was the best time to quit, and that quitting would not threaten their sobriety. Using cluster analysis, four subgroups of inpatients with different levels of interest, confidence, and motivation regarding quitting smoking were identified. Our inpatients' positive attitudes about quitting smoking stand in contrast with previously reported attitudes of many health professionals, and suggest that inpatient treatment could be an opportune time to provide stop-smoking interventions. Findings also suggest that different treatment approaches may be needed for subgroups of inpatients with varying attitudes about quitting.

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Thirty-four veterans of a residential rehabilitation program for homelessness and substance abuse participated on a community-based softball team. Compared to nonparticipants, participants stayed in treatment longer and were more likely to complete all aspects of the program (inpatient and outpatient). They also were more likely to be abstinent from drugs/alcohol, employed, and housed 3 months postdischarge. Participation appeared to enhance outcomes by providing in vivo opportunities for practicing coping skills and developing supportive relationships. A softball program may be a viable adjunct treatment in which formally taught cognitive-behavioral skills can be applied in a natural, but semistructured setting.

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The impact of a smoking cessation program on substance abuse inpatients was investigated. Thirty-nine male veterans were randomly assigned to stop-smoking (n = 19) or wait-list conditions (n = 20), and followed up 3- and 6-months postdischarge. Compared to wait-list subjects, stop-smoking subjects were more likely to continue inpatient treatment at least 30 days following study enrollment and reported greater posttreatment reductions in cigarette nicotine delivery. Importantly, assessments of postdischarge substance use and hospital readmission rates did not reveal any adverse effects from participation in the stop-smoking program.

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This study gathered descriptive data on 163 individuals who applied by telephone to a residential rehabilitation program for homeless veterans and compared these data with general veteran and homeless populations. Ss were a young (M = 40.82 years) and educated (M = 13.34 years of schooling) subgroup of homeless men (98.16%) with histories of relatively high, stable functioning (e.g., previous successful employment) and high rates of medical (47.47%), substance abuse (67.1%), psychiatric (41.93%; primarily nonpsychotic), and legal (71.15%) problems. These characteristics appear to be different from those of other subgroups of homeless (e.g., homeless chronically mentally ill, skid-row alcoholics), and they provide a basis for beginning to develop distinct remedial strategies that are specific to this subpopulation. The advantages of studying subgroups of homeless and the utility of the telephone interview data collection methodology are discussed.

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